How To Decrease Eating Issues During Mealtime Issues
Children With Autism And Eating Issues During Mealtime
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Eating issues are very common among people with ASD. Their insistent behavior can carry over to what kind of food they like to eat. Sometimes a food is liked or disliked due to its texture or smell or the color. Sometimes the food is eaten only if it is fresh. No leftovers. Sometimes it has to do with the presentation: certain foods cannot be mixed together. They have to be separated, or they will not be eaten. It may also depend on who prepared it. If the food was not prepared by themselves or by a parent, the food will not be eaten.
Typical people have certain preferences about food as well. The difference is that people with ASD will be much more defiant. They may have big tantrums that can last for a long time. Even if they are hungry and there isn’t any other food available, they may still not eat the food because, for example, the jello was not put in his favorite bowl. Another example is even though the child may love to eat M&M’s, she will only eat it if it is a certain color. M&M’s come in various colors, but they all taste the same. Red is not cherry flavor and yellow is not banana flavor.
Eating issues are different from other kinds of defiant behaviors because you cannot follow through. If the child does not want to eat, you cannot put food in his mouth and make him chew. In addition, eating issues cannot be ignored. Being hungry affects every part of the child’s life, therefore, parents often have to “give in” and give the child want he wants. This “giving in” though is a temporary solution for that particular meal, but “giving in” reinforces the defiant behavior and makes following directions for future meals that much more difficult. Below are some procedures that should be able to solve your child’s eating issues.
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Before beginning the procedures below, try to figure out why your child is not eating? Does your child show any pain when eating? If so, ask him to tell you where, or ask him to point to where it hurts. See a doctor or a dentist if there are signs of pain. Another reason why the child may not be eating is because he has become bored of eating the same food many times. People with ASD cannot always say the reasons for their behavior. They may just react to the situation. Consider the food the person has eaten and how long they have eaten it. Has it been the same food cooked the same way for a long period of time? Try offering more variety of foods, which will not only help solve the eating issues but also teach him to expand his thinking and be more flexible.
Before Beginning The Procedure
Rule out foods that might make him feel uncomfortable after he eats it. Double check the food is not spoiled. It depends on their level of functioning but the child with Autism might not be able to tell you if the food is spoiled or not.
Before beginning the procedures below, try to figure out why your child is not eating? Does your child show any pain when eating? If so, ask him to tell you where, or ask him to point to where it hurts. See a doctor or a dentist if there are signs of pain. Another reason why the child may not be eating is because he has become bored of eating the same food many times. People with ASD cannot always say the reasons for their behavior. They may just react to the situation. Consider the food the person has eaten and how long they have eaten it. Has it been the same food cooked the same way for a long period of time? Try offering more variety of foods, which will not only help solve the eating issues but also teach him to expand his thinking and be more flexible.
Procedure To Decrease Behavior Issues During Mealtime
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I. Assessment (insert picture of two lists)
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First, do an assessment by making two lists: foods the child likes to eat and foods he does not like to eat during meals. The foods he likes to eat will be used as reinforcers to motivate him to eat the foods that he doesn’t like. From the list of dislike foods, determine which ones you think he should eat in order to give him a healthy diet. For example, vegetables are often on the list of dislike foods, but vegetables are necessary for a healthy balanced diet.
II. Decide on the reinforcer (insert picture of dessert, toy, video games, TV set)
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Second, think of a reinforcer that the child can have after finishing all his food. This can be a dessert, a drink, toy, or video he can have afterwards. To increase the reinforcing properties of this item, offer this reinforcer only after he finishes his meals. Do not let him have it at any other times.
III. Decide on the goal (insert picture of a big bowl of food and a small bowl with a small amount of food)
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Third, determine how much food you want your child to eat. Letting him know exactly the amount he has to eat will decrease anxiety and lets him know the goal he has to achieve. In terms of measuring, this depends on the food that is being served. For example, if dinner is spaghetti or fried rice in which meat, vegetables, etc. are all served in one dish, give him a certain amount and tell him he has to finish the bowl. Do not give him the option of putting the food in the bowl by himself.
If the meal consists of separate dishes like a meat, different vegetables, or side dishes, then you can either mix all the different variety into one bowl, or separate the food into little bowls/dishes. Keep in mind as you prepare the food into the bowls/plates, try to make it look appealing. If the food looks good to him, then you do not have to do a lot to motivate him to eat it.
IV. Prepare these items ahead of time:
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- A visual timer in which the child can see the time count down to zero by the decreasing amount of color left on the timer (see figure below). There are many free timer apps like OVO and for android and OS operating systems.
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- Extra bowls. The child will eat out of these bowls. They should not be too big or heavy so that the child being able to use them is not an issue.
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- Scissors for cutting food and extra utensils that will be used to move food from one bowl to another. Plate to put all the utensils.
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- Tissue for wiping mouth and hands
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(Insert picture of OVO timer on cell phone, big bowl, small bowl, scissors, tissue, chopsticks, fork, spoon)
Common Feeding Issues Shown By People With Autism
1. Does not want to eat any of the food given to him.
2. Likes only certain foods but will not eat other kinds of food like vegetables
1. Feeding issue: Does not want to eat any of the food given to him
This could be a very challenging scenario. Continue to try different kinds of food. Think of what he likes and then try other foods in that category. Also, think of food with the same texture, color, smell, or even size. For example, if he likes a certain meat, try other meats. If he likes a certain vegetable, find others with the same color or texture.
As for motivation, pick out items on the positive reinforcer list that mean the most to him. If he likes certain videos, save those for eating time. Only offer this strong reinforcer during this time, which means if he really likes a particular video, the only way he can watch it is by eating his food. Make sure that other family members, other therapists, and teachers know to not give him that reinforcer as well; otherwise, it will not be a strong reinforcer if he can get it from another method.
Strategy:
a. Ask the child what he wants if he finishes eating the food given to him. If he decides not to choose a reinforcer, tell him, “If you do not choose a reward (might not know what reinforcer is), I will choose for you.” Decide for him if he doesn’t choose then next time he will choose.
b. Put a small amount into a bowl, and tell him if he eats all of it, he can have what he wants. If what he wants is some food like candy or cookies, give him a small amount. When deciding what to give him, think about what if he ate the total amount that you requested. For example, if you offer him one M&M for each portion he ate and you split the meal into 6 portions, this means you will give him 6 M&M to eat during dinner. If you can accept that, then let him know the rule so he can know what to expect: “After eating each portion, you can have one M&M.”
c. Once the child is eating more consistently, you can change the rule by making the portions that he is required to eat bigger. Keep changing the criteria if he continues to eat more consistently. The goal is to tell him, “You can have the reinforcer after you eat everything.” The ultimate goal will be you do not have to offer reinforcers at all.
2. Feeding issue: Likes only certain foods but will not eat other kinds of food like vegetables
Strategy:
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Option one: If your child, for example, only wants meat and not the vegetables, cut all the food into small pieces so that it would be too time consuming to pick out all the disliked vegetables.
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Option two: If your child is more compliant, try this option in which you do not need to cut all the food into small pieces. If like before, he only wants meat and not the vegetables, first cut the meat into bite sizes. Put a small amount of meat and some vegetables into a small bowl/plate. Tell the child he has to finish everything in the bowl and then he can have more of the meat. If he doesn’t finish everything in the bowl, do not give him any more meat. You will basically be telling the child, if you want to eat the food you like, you have to eat all the other food too. Giving small amounts at a time makes eating the disliked food easier.
Important things to prepare for:
a. The child might eat just the desired meat and leave the disliked vegetables in the bowl. Mentally prepare yourself for this, and do not give in. Remind him he has to eat everything in the small bowl before he can have more. You can show him the desired meat in the other bowl, and say, “If you want more, finish everything in your bowl.” Also, remind him of the reinforcer he can have if he finishes his entire meal. You can do this by showing him, for example, the cake he wants, a picture of the video he wants to see, or the toy that he wants, etc.
b. After eating all the desired items and not eating the dislike food in the small bowl, he might just sit and wait. To prevent waiting for long periods, tell him the reinforcer he gets for eating the entire meal will start to decrease. For example, if he wants a piece of cake, cut one piece for him and then tell him if he does not start eating before the timer rings, you will cut 1/5 of the cake. Get out the visual timer, and set it for 1 minute. If the timer rings and he has not started eating yet, cut 1/5 of the cake.
Do not give in! If you give him more of the desired meat before he finishes everything in the small bowl, he will not take you seriously anymore. This procedure will then likely not be effective because he knows you will not follow through.
c. While working on these strategies, prevent any snacking during meals. If he is not hungry during meal time, he will less likely want to eat anything especially the disliked food. At the same time, the hungrier he is, the more likely he wants to eat even the food that he doesn’t like. Also, if he knows he can eat snacks after meals, then he will likely not eat the disliked food during the meals.
Option two can be used when the child is more compliant. If the child is not complying with this option, go back to the first option of cutting all the food into small pieces.
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Keep in mind:
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- A hungry child will require less motivation to eat. Prevent him from having snacks before meals and even watch how much he drinks since the fluid can make him feel full. It’s important to let everyone in the house know this; otherwise, they may give him food. A very difficult situation could arise if he was given some food and you did not know about it. In that case, you will be asking a child who has feeding issues to eat more when he is already full. He likely will not eat and then you will unknowingly keep trying. Avoid this stress and know exactly what he ate before meals.
- Ask the child what he wants to eat. If he has some input in the food choices, he will likely be more willing to eat it. Some children have difficulty selecting foods because they cannot remember what food they liked in the past. To help the child select, show him some pictures of the food that you think he likes. Go to google.com and type in the food item then click on “Image” to see pictures of this food. You can also go to ubereats.com and find a supermarket. They will show pictures of many of the food items at the store. In the future, take pictures of the food he eats especially the ones he likes. Teach him the name of the food so that he can ask for it again in the future.
- If a child likes a certain food, try to find variations of it. For example, if he likes spaghetti, try different kinds of sauce or noodles. You can vary the kind of meat/vegetables they you put in the sauce. If he likes sandwiches, try different meats, cheeses, breads, vegetables, and sauces to give him some variety. Show him pictures of the food, or show him how someone on youtube.com makes the food. There are thousands of recipes on youtube.com that you can get ideas from. Doing these things may make him more interested in the food. You can also ask him to join you to make the food. You can then tell him he made it, which will offer more motivation to eat it.
- When starting, try to use food that can be cut up into small pieces and mixed altogether. By doing this, you will deter the child from wanting to pick out the pieces he doesn’t want to eat. For example, cut the meat and vegetables into small pieces and then mixing them with the rice will ensure the child will eat all the ingredients in each bite and also make it difficult to pick out the items he doesn’t like.
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Important Decision To Make Before Starting The Procedure
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During the meal your child might test you and not want to eat any of the food you planned. You should decide before trying these strategies if you can accept this. Feed issues can be very challenging because you cannot follow through. You cannot put the food in his mouth; therefore, you have to be strong. If he misses a meal, he will be quite hungry for the next meal, which will make him even more motivated to eat.
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